Melbourne Institute of Applied Economic and Social Research and The Centre for Microeconometrics, The University of Melbourne, Parkville, Victoria, Australia.
Health Econ. 2010 Dec;19(12):1404-24. doi: 10.1002/hec.1560.
This paper proposes a method of deriving a quality indicator for hospitals using mortality outcome measures. The method aggregates any number of mortality outcomes into a single indicator via a two-stage procedure. In the first stage, mortality outcomes are risk-adjusted using a system of seemingly unrelated regression equations. These risk-adjusted mortality rates are then aggregated into a single quality indicator in the second stage via weighted least squares. This method addresses the dimensionality problem in measuring hospital quality, which is multifaceted in nature. In addition, our method also facilitates further analyses of determinants of hospital quality by allowing the resulting quality estimates be associated with hospital characteristics. The method is applied to a sample of heart-disease episodes extracted from hospital administrative data from the state of Victoria, Australia. Using the quality estimates, we show that teaching hospitals and large regional hospitals provide higher quality of care than other hospitals and this superior performance is related to hospital case-load volume.
本文提出了一种利用死亡率结果指标来推导医院质量指标的方法。该方法通过两阶段程序将任意数量的死亡率结果汇总为一个单一指标。在第一阶段，使用似乎不相关的回归方程系统对死亡率结果进行风险调整。然后，在第二阶段，通过加权最小二乘法将这些经风险调整的死亡率汇总为一个单一的质量指标。该方法解决了衡量医院质量的多维性问题，因为医院质量本质上是多方面的。此外，我们的方法还通过允许将得出的质量估计与医院特征相关联，为进一步分析医院质量的决定因素提供了便利。该方法应用于从澳大利亚维多利亚州医院管理数据中提取的心脏病发作样本。使用质量估计，我们表明教学医院和大型区域医院提供的护理质量高于其他医院，这种卓越表现与医院病例量有关。
